Provider Demographics
NPI:1265030522
Name:STOFF, JENNA (MS)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:STOFF
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 MONTGOMERY BLVD NE STE 215
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2579
Mailing Address - Country:US
Mailing Address - Phone:505-999-7873
Mailing Address - Fax:
Practice Address - Street 1:9500 MONTGOMERY BLVD NE STE 215
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2579
Practice Address - Country:US
Practice Address - Phone:505-247-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCF7233235Z00000X
NMSLP7541235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist